Real-World Pattern-of-Care Analysis of Primary Cutaneous Lymphomas Radiation Therapy Among European Organisation for Research and Treatment of Cancer Members

Khaled Elsayad; Emmanuella Guenova; Beatrice Fournier; Carolina Fernandes; Enrico Clementel; Evangelia Papadavid; Marie Beylot Barry; Felix Pavlotsky; Chalid Assaf; Pablo L Ortiz-Romero; Vassilis Kouloulias; Adele de Masson; Stephane Dalle; Pierre Clavère; Max Schlaak; Nina Booken; Marion Wobser; Christina Mitteldorf; Barzilai Aviv; Virgínia Mareco; Fernando Gallardo; Reinhard Dummer; Markus Gross; Felix Ehret; Andrea Lancia; Bartłomiej Tomasik; Lorna Hawley; Vincent Rermouchamps; Mona Abdel-Halim Ibrahim; Ahmed Gawish; Mohamed Abouegylah; Martin Stuschke; Adinda Baten; Hans Theodor Eich; Lena Specht; Mario Levis; Stephen Morris; Belinda Campbell; Jan P Nicolay; Richard Cowan; Dora Correia; EORTC Cutaneous Lymphoma Tumour Group

doi:10.1016/j.ijrobp.2024.11.011

Real-World Pattern-of-Care Analysis of Primary Cutaneous Lymphomas Radiation Therapy Among European Organisation for Research and Treatment of Cancer Members

Int J Radiat Oncol Biol Phys. 2024 Nov 14:S0360-3016(24)03581-8. doi: 10.1016/j.ijrobp.2024.11.011. Online ahead of print.

Authors

Khaled Elsayad¹, Emmanuella Guenova², Beatrice Fournier³, Carolina Fernandes³, Enrico Clementel³, Evangelia Papadavid⁴, Marie Beylot Barry⁵, Felix Pavlotsky⁶, Chalid Assaf⁷, Pablo L Ortiz-Romero⁸, Vassilis Kouloulias⁹, Adele de Masson¹⁰, Stephane Dalle¹¹, Pierre Clavère¹², Max Schlaak¹³, Nina Booken¹⁴, Marion Wobser¹⁵, Christina Mitteldorf¹⁶, Barzilai Aviv⁶, Virgínia Mareco¹⁷, Fernando Gallardo¹⁸, Reinhard Dummer¹⁹, Markus Gross²⁰, Felix Ehret²¹, Andrea Lancia²², Bartłomiej Tomasik²³, Lorna Hawley²⁴, Vincent Rermouchamps²⁵, Mona Abdel-Halim Ibrahim²⁶, Ahmed Gawish²⁷, Mohamed Abouegylah²⁸, Martin Stuschke²⁹, Adinda Baten³⁰, Hans Theodor Eich³¹, Lena Specht³², Mario Levis³³, Stephen Morris³⁴, Belinda Campbell³⁵, Jan P Nicolay³⁶, Richard Cowan³⁷, Dora Correia³⁸; EORTC Cutaneous Lymphoma Tumour Group

Affiliations

¹ Radiation Oncology, University Hospital of Muenster, Muenster, Germany; Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Marburg, Germany; Department of Radiotherapy and Radiation Oncology, Philipps-Universität Marburg, Marburg, Germany; Marburg Ion-Beam Therapy Center (MIT), Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Marburg, Germany; University Cancer Center (UCT) Frankfurt - Marburg, Marburg, Germany. Electronic address: [email protected].
² Department of Dermatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; University Institute and Clinic for Immunodermatology, Medical Faculty, Johannes Kepler University, Linz, Austria.
³ European Organisation for Research and Treatment of Cancer, Headquarters, Brussels, Belgium.
⁴ 2nd Department of Dermatology, National and Kapodistrian University of Athens, Attikon University Hospital, Greece.
⁵ Department of Dermatology, University Hospital of Bordeaux and INSERM U1312, France.
⁶ Dermatology Department, Sheba Medical Center Tel Hashomer, Israel.
⁷ Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; Institute for Molecular Medicine, Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany; Department of Dermatology, HELIOS Klinikum Schwerin, University Campus of The Medical School Hamburg, Schwerin, Germany.
⁸ Department of Dermatology, Institute i+12, Hospital 12 de Octubre Medical School, University Complutense, Madrid, Spain.
⁹ Department of Radiation Oncology, National and Kapodistrian University of Athens, Attikon University Hospital, Greece.
¹⁰ Department of Dermatology, APHP, Saint-Louis University Hospital, Paris, France.
¹¹ Department of Dermatology, Hospices Civils de Lyon, Pierre Bénite CEDEX, France.
¹² Department of Radiotherapy, Centre Hospitalier Universitaire de Limoges, Limoges, France.
¹³ Department of Dermatology, Venereology and Allergology, Charite - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
¹⁴ Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁵ Department of Dermatology, Universitaetsklinikum Wuerzburg, Germany.
¹⁶ Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Germany.
¹⁷ Radiotherapy Department, Unidade Local de Saúde Santa Maria, EPE, Portugal.
¹⁸ Department of Dermatology, Hospital del Mar, Barcelona, Spain.
¹⁹ Department of Dermatology, University Hospital Zurich, Switzerland.
²⁰ Department of Radiooncology, University Hospital Basel, Basel, Switzerland.
²¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.
²² Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
²³ Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.
²⁴ Bristol Haematology and Oncology Centre, Bristol, United Kingdom.
²⁵ Radiation Oncology Department, CHU UCL Namur, Site Sainte Elisabeth, Namur, Belgium.
²⁶ Dermatology Department, Ain Shams University, Cairo, Egypt.
²⁷ Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Marburg, Germany; Department of Radiotherapy and Radiation Oncology, Philipps-Universität Marburg, Marburg, Germany; Marburg Ion-Beam Therapy Center (MIT), Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Marburg, Germany; University Cancer Center (UCT) Frankfurt - Marburg, Marburg, Germany.
²⁸ Department of Clinical Oncology, Alexandria University Hospital and Ayadi Al-Motakbal Hospital, Alexandria, Egypt.
²⁹ Department of Radiation Oncology, University Hospital Essen, Germany.
³⁰ Department of Radiation Oncology, UZ Leuven, Leuven, Belgium.
³¹ Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
³² Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
³³ Department of Oncology University of Torino, Torino, Italy.
³⁴ Guy s and St Thomas' NHS - Guy's Hospital, London, United Kingdom.
³⁵ Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia.
³⁶ Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Mannheim, Germany.
³⁷ Department of Clinical Oncology, Christie Hospital, University of Manchester, Manchester, United Kingdom.
³⁸ Department of Radiation Oncology, Cantonal Hospital Aarau, Aarau, Aargau, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.

PMID: 39549760
DOI: 10.1016/j.ijrobp.2024.11.011

Abstract

Purpose: We aim to determine the current treatment patterns and recommendations among physicians for cutaneous lymphomas and to identify the types of skin lymphomas for which existing radiation regimens need improvement.

Methods and materials: A questionnaire from the European Organisation for Research and Treatment of Cancer was distributed to all members of the Cutaneous Lymphoma Tumour Group and Radiation Oncology Scientific Council. This online survey included 13 questions regarding treatment practices for patients with cutaneous lymphoma. The survey was conducted from August 21 to December 18, 2023. Frequency distributions and subgroup comparisons were calculated and analyzed.

Results: We collected 51 completed questionnaires from investigators from 19 countries specializing in cutaneous lymphoma treatment. Radiation doses varied significantly (range, 4-60 Gy). Based on the histologic entity, up to one-third of the investigators delivered hypofractionated regimens (range, 14%-35%). Reduced-dose radiation therapy (RT) was considered by 27% to 63% of investigators. Meanwhile, 18 (35%) investigators considered adapting the radiation dose to the response to immunochemotherapy when treating primary cutaneous diffuse large B cell lymphoma-leg type. Regarding total skin electron beam therapy, 91% of centers delivered reduced-dose regimens, and 18% of investigators applied ultrahypofractionated protocols.

Conclusions: RT in patients with cutaneous lymphoma is highly heterogeneous among the European Organisation for Research and Treatment of Cancer centers. The development of evidence-based recommendations for RT dose, fractionation, and technique for cutaneous lymphomas is required for optimization and standardization of treatment.